Key result
The editorial debates the technological shift toward minimal access robotic-assisted liver surgery and questions whether it will completely replace open surgery.
The editorial argues that despite the technological advancements of minimal access and robotic-assisted liver surgery, open surgery should still maintain a prominent role.
The quote referring to the Kingdom of Cancer stating that ‘Biology is King; selection of cases is Queen … and the technical details of surgical procedures are princes and princesses …’1 is often repeated in medical meetings and as introduction to lectures, just to remind surgeons about the indication for surgery and the limitations to technical details. This analogy of hierarchic step down within the realms of cancer biology has in part been mitigated by novel technological insights. Indeed, minimal access surgery2 (first laparoscopy and now robotic-assisted surgery) have attracted the attention of liver surgeons. Robotic-assisted surgery undoubtedly represents a leap forward in surgical technology. An effective and considerable communications and marketing strategy celebrating robotic-assisted surgery as the epitome of precision and innovation has to some degree left an impression of the death of open surgery (as in ‘open access’) within the surgical community. The question thus remains, with this ‘Gloves off’ debate in perspective, are we really looking at something like the technological shift that occurred in the transition from the candle to the light bulb? The light bulb of the lamp allowed for better illumination and did so with better safety (less risk of fire) than the candle. As such, the technology provided a major change. In my view, this resembles what we are now seeing with the introduction of minimal-access liver surgery2 and particularly with the newcomer of minimal access robotic-assisted liver surgery (MARLS). The question then becomes whether MARLS will provide a global advantage to the extent where we may consider the extinction of open surgery, similar to the analogy of the candle and the light bulb.
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Guido Torzilli (2025) conducted an editorial in Liver cancer. Minimal access robotic-assisted liver surgery (MARLS) vs. Open surgery was evaluated. The editorial debates the technological shift toward minimal access robotic-assisted liver surgery and questions whether it will completely replace open surgery.
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